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SUBSTANCE RELATED DISORDERS

Dr. Hassan Sarsak, PhD, OT

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TERMINOLOGY Substance abuse: a repeated and excessive use

of a substance that is harmful or potentially harmful to the user’s life, despite knowing that it is causing a problem or making an existing one worst, for at least one month and that the use of it does cause dependence, occurs mostly between ages 18-24.

Addiction and dependence: is the chronic, excessive use of substance that is harmful to the individual, it is characterized by physical tolerance???, physiological dependency, deterioration in overall function, and marked loss of control over frequency and amounts of the substance used.

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TERMINOLOGY Tolerance: diminished effects from

taking the same amount of substance and the need to use increasing amounts (need for overdose) to experience the same effect.

Withdrawal: refers to the symptoms (specific to the substance) that occur with decreased or discontinuation of the substance use.

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TERMINOLOGYDependence could be:

Physical dependence is promoted by phenomenon called tolerance: the need for higher doses of substance to obtain the desired effect.

Psychological dependence: the user perceived the necessity of the substance to maintain optimal state of personal well-being, interpersonal relations, or skill performance.

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DSM-IV DIAGNOSTIC CRITERIA“FOCUS IS ON SUBSTANCE DEPENDENCE”

Three of the following MUST be present: The substance is often taken in larger amounts

of over a longer period of time than intended. There exist a persistent desire or there have

been one or more unsuccessful efforts to cut down or control the substance use

A great deal of time is spent in activities necessary to get the substance, in taking the substance, or in recovering from its effects.

There occur frequent intoxication or withdrawal symptoms at times when the person is expected to fulfill major role obligations at work, school, or home or when substance use is physically hazardous.

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DSM-IV DIAGNOSTIC CRITERIA (CONT’D)

Important social, occupational, or recreational activities are given up or reduced because of substance use

There continued substance use despite the user’s knowledge of having a persistent or recurrent social, psychological, or physical problem that is caused or exacerbated by the use ( e.g., the person continues using despite family arguments about heroin, cocaine-induced depression, or an ulcer that is made worse by drinking).

There are characteristic withdrawal symptoms*

The substance is taken to relieve or avoid withdrawal symptoms*

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DSM-IV DIAGNOSTIC CRITERIA (CONT’D)

There is marked tolerance involving the need for continually increasing amounts of the substance ( i.e., at least a 50% increase) in order to achieve intoxication or the desired effect and a markedly diminished effect with continued use of the same amount.

* May not apply to cannabis (hashish), hallucinogens (ecstasy, phencyclidine (PCP))

*To meet the criteria for substance abuse, some symptoms of disturbance* must persist for at least one month or have occurred repeatedly over a longer a period of time (e.g., within 12 months).

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TYPES OF SUBSTANCE Alcohol: most widely abused substance.

It comes in various strengths or proofs. E.g., Wine 13 proof (6% alcohol) vodka, whisky, and others come in a proof of 60-100 (30-60% alcohol)

Lever can metabolize an average of one ounce an hour

Intoxication occurs when the blood level reach 0.08%

Signs of intoxication includes: impaired function, slurred speech, incoordination, unsteady gait, nystagmus, flushed face, and alcohol myopia (decreased cognitive capacity). Intoxication occurs when blood alcohol level between 100-200 mg/dl.

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ALCOHOL (CONT’D) The most widely abused drug in US. Alcoholism developed in four phases:1. Prealcoholic phase: the use of alcohol to

relieve the every day stress and tensions of life.

2. Early alcoholic phase: blackouts (brief period of amnesia occur during the period of drinking) are evident.

3. The crucial phase: Loss of control, physiological dependence. Sickness, anger and aggression.

4. The Chronic phase: emotional and physical disintegration. Intoxication.

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ALCOHOL (CONT’D) Alcohol induce a general, nonselective,

reversible depression of the CNS (depressing brain activity).

Absorption of alcohol is delayed if taken sipped, stomach contains food, and if beer and wine.

At low doses, alcohol produce relaxation, relaxed inhibition, lack of concentration, drowsiness, slurred speech, and sleep.

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COMPLICATION OF ALCOHOL ABUSE Peripheral neuropathy Alcoholic myopathy Wernicke’s encephalopathy Korsakoff’s psychosis syndrome Alcoholic cardiomyopathy Esophagitis Gatritis Pancreatitis Alcoholic hepatitis Liver cirrhosis Luekopenia Thrombocytopenia Sexual dysfunction

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OTHER TYPES OF SUBSTANCE

Hallucinogens like LSD, mescaline, MDMA “ecstasy”, MDA, MDM and psilocybin used to alter reality by introducing an overwhelming sensory experience…

Will talk about it again later in the slides….

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OTHER TYPES OF SUBSTANCE (CONT’D)

Cannabis like Marijuana may cause talkativeness, increased appetite, destorted sense of time and space, impaired intellectual performance, serious paranoid ideation and feeling depersonalization?!* Chronic use of more than three time results in addiction

Cocaine: is a stimulant grown from coca plants and distilled into white powder (that can inhaled through the nose or injected and producing an intense sensation of pleasure lasting 20 minute -1.5 hour Crack is crystallized form of it and can be smoked A long-term user of cocaine may well develop symptoms

of other psychological disorders, such as major depression, phobia, and eating disorders

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OTHER TYPES OF SUBSTANCE (CONT’D)

Amphetamines and other stimulants: are manufactured from chemicals and can be injected, smoked, joint, or cigarette, swallowed (pills), mixed with other beverages. Effect last for 4-8 hoursMay cause malnutrition, sleep deprivation,

extreme impulsivity, paranoid and delusion.

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OTHER TYPES OF SUBSTANCE (CONT’D) Narcotics: are pain killers, which cause

sedation euphoria and impaired intellectual, function, and impaired coordination Include heroin, codeine, opium, morphine

and Percodan, Demerol, and darvon.

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THEORIES OF ADDICTION

Biopsychosocial: as a disease Biological: genetics (family studies and adoption),

biochemical Brain Receptors Genetics Genetic and biological factors are less influential factors

than social and cultural experiences (e.g., difficult temperament, intrapersonal factors) in developing addiction.

Psychological component: developmental influences, personality factors.

Sociocultural component: social learning (relationship among family, peers..), conditioning (substance use is reinforced by a stimulus like a stress or anger..), cultural and ethnic influences, religion.

Dual diagnosis (co-occurring disorders, COD)

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SEDATIVE, HYPNOTIC, OR ANXIOLYTIC ABUSE AND DEPENDENCE These drugs (barbiturates, none barbiturates

hypnotics, and anti-anxiety) are capable of inducing varying degrees of CNS depression.

CNS depressants:1. Are addictive with one another and with

behavioral state of the user.2. Have no specific antagonist to block its

action.3. In low doses, it produces an initial excitatory

response.4. Are capable of producing physical and

psychological dependency.5. May have cross-tolerance and cross-

dependence.

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The sedative-hypnotic-anxiolytic compounds induce a general depressant effect (depression in the activity of the brain, muscle, and heart tissue).

Physiological effect of the sedative-hypnotic-anxiolytic includes:

1. Effect on sleep and dream 2. respiratory depression3. Hypotension, cardiac arrhythmias*.4. high doses affect hepatic, renal function.5. Decrease body temperature.6. Sexual dysfunction.

SEDATIVE, HYPNOTIC, OR ANXIOLYTIC ABUSE AND DEPENDENCE (CONT’D)

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CNS STIMULANT ABUSE AND DEPENDENCE

The most prevalent and widely used stimulants are : caffeine and nicotine. Other examples are cocaine, amphetamines, and Ecstasy

If used moderately, they produce a fatigue relief and increase alertness.

CNS stimulants have physiological effect on:

1. Increase alertness, decrease fatigue, elation and euphoria, muscular power.

2. Increase HR, BP, arrhythmias.3. Decreased GIT motility.4. When overdosed might lead to sexual

dysfunction

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INHALANTS ABUSE AND DEPENDENCE

Inhalant disorders are induced by inhaling the aliphatic and aromatic hydrocarbons.

Methods of use include: huffing and bagging.

Effect of the inhalants is relatively short. Effects (CNS depressant) includes:1. Nervous system damage, neurological

defects.2. Respiratory problems.3. abdominal pain, nausea, vomiting.4. Chronic renal failure

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OPIOID ABUSE AND DEPENDENCE (HEROIN)

Opioid exerts sedative and analgesic effect. These products used medically for pain

(painkiller). Effects of opiates (narcotic analgesics):1. Strong sense of euphoria, mood change,

mental clouding, sedation 2. pupil constriction, respiratory depression.3. Constipation and fecal impaction.4. Hypotension.5. Decrease libido (sexual desire), retarded

ejaculation, impotence, orgasm failure.

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HALLUCINOGEN ABUSE AND DEPENDENCE

Hallucinogenic substances are capable of distorting an individual’s perception of reality (alter sensory perception).

Hallucinogenic use is episodic. They include LSD, Mescaline, and ecstasy

There are two types of toxic reactions:1. Panic reaction: intense anxiety and fear.2. Flashbacks (déjà vu Movie): transient,

spontaneous repetition of LSD experiences that occur in the absence of the substance.

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CANNABIS ABUSE AND DEPENDENCE“HASHISH”

The second most widely abused substance after alcohol (CNS depressant)

Examples: Marijuana, hashish. Effects include:1. Tachycardia, orthostatic hypotension.2. Respiratory problems.3. Decrease testosterone, failure to ovulate.4. euphoria, relaxed inhibition.5. Long use produce amotivational

syndrome (students: add “a”!!!.6. Enhance sexual experience.